~ Leukemias & Lymphomas~

Meet the Kids Fighting Leukemias, Angles, & the Survivors

What is Leukemia?

Leukemia is a type of cancer that affects the blood and bone marrow; the spongy center of bones where our blood cells are formed. The disease develops when blood cells produced in the bone marrow grow out of control.

How many types of Leukemia are there?

There are many types of Leukemia and subtypes.

The most common types of Leukemias:

Acute Lymphoblastic Leukemia (ALL)

Acute Myeloid Leukemia (AML)

Chronic Lymphocytic Leukemia (CLL)

Chronic Myeloid Leukemia (CML)

Blood cell development. A blood stem cell goes through several steps to become a red blood cell, platelet, or white blood cell.

* NOTE Acute Leukemias cells know as "blasts" (young cells) divide quickly and out of control, unlike chronic leukemias were the mature cells become abnormal and grow and accumalste over a longer peroids of time.

Other Types of leukemias:

Hairy Cell Leukemia

Chronic Myelomonocytic Leukemia (CMML)

Juvenile Myelomonocytic Leukemia (JMML)

Subtypes Of ALL:

ALL-L1: small uniform cells

ALL-L2: large varied cells

ALL-L3: large varied cells with vacuoles (bubble-like features

* Each subtype is then further classified by determining the surface markers of the abnormal lymphocytes, called immunophenotyping. There are 2 main immunologic types: pre-B cell and pre-T cell. The mature B-cell ALL (L3) is now classified as Burkitt's lymphoma/leukemia. Subtyping helps determine the prognosis and most appropriate treatment in treating ALL.

T - Cell ALL:

Philadelphia-positive ALL (Ph+ ALL)

Acute T-lymphoblastic leukemia *Newly identify in 2009

Natural killer (NK) cell leukemia

B - Cell ALL:

Acute B-lymphoblastic leukemia

Acute precursor B-cell leukemia

Pre B-cell lymphoblastic leukemia

Subtypes of AML: There are 8 types identified

M0 - Undifferentiated acute myeloblastic leukemia

M1 - Acute myeloblastic leukemia with minimal maturation

M2 - Acute myeloblastic leukemia with maturation

M3 - Acute promyelocytic leukemia (APL)

M4 - Acute myelomonocytic leukemia

M4 eos - Acute myelomonocytic leukemia with eosinophilia

M5 - Acute monocytic leukemia

M6 - Acute erythroid leukemia

M7 - Acute megakaryoblastic leukemia

AML not otherwise specified: This section includes cases of AML that don't fall into one of the groups <---- (on the left)

Undifferentiated AML (M0)

AML with minimal maturation (M1)

AML with maturation (M2)

Acute myelomonocytic leukemia (M4)

Acute monocytic leukemia (M5)

Acute erythroid leukemia (M6)

Acute megakaryoblastic leukemia (M7)

Acute basophilic leukemia

Acute panmyelosis with fibrosis

Myeloid sarcoma (also known as granulocytic sarcoma or chloroma)

*NOTE: Undifferentiated or biphenotypic acute leukemias (leukemias that have both lymphocytic and myeloid features). Sometimes called ALL with myeloid markers, AML with lymphoid markers, or mixed lineage leukemias.

Difficulty breathing (dyspnea); With T-cell ALL, these leukemia cells tend to clump together around the thymus. This mass of cells present in the middle of the chest can cause pain and difficulty breathing (dyspnea). Wheezing, coughing, and/or painful breathing requires immediate medical attention.

How Is Childhood Leukemia diagnosed?

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

Complete blood count (CBC) with differential (dif):A procedure in which a sample of blood is drawn and checked for the following:

The number of red blood cells and platelets.

The number and type of white blood cells.

The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.

The portion of the sample made up of red blood cells.

Bone marrow aspiration and biopsy:The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.

Cytogenetic analysis:A laboratory test in which the cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes in the lymphocytes. For example, in Philadelphia chromosome-positive ALL, part of one chromosome is moved to another chromosome. This is called the “Philadelphia chromosome.” Other tests, such as fluorescence in situ hybridization (FISH), may also be done to look for certain changes in the chromosomes.

Immunophenotyping:A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant lymphocytes (cancer) began from the B lymphocytes or the T lymphocytes.

Blood chemistry studies:A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organsand tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.

Chest X-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Lumbar puncture:A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.

Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.

Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.

Philadelphia chromosome. A piece of chromosome 9 and a piece of chromosome 22 break off and trade places. The bcr-abl gene is formed on chromosome 22 where the piece of chromosome 9 attaches. The changed chromosome 22 is called the Philadelphia chromosome.

Computed Tomography Scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Magnetic Resonance Imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Ultrasound (Also called sonography.) - a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

Lymph node biopsy- a sample of tissue is removed from the lymph node and examined under a microscope.

How is Leukemia staged?Unlike most solid tumors, there is no standard staging system for leukemia, however there is a risk group

Standard (low) risk:Includes children aged 1 to 9 years who have a white blood cell count of less than 50,000/µL at diagnosis.

High risk:Includes children younger than 1 year or older than 9 years and children who have a white blood cell count of 50,000/µL or more at diagnosis.

What Are the Treatment Options For Childhood Leukemia?

Chemo

Radiation Therapy

Surgery

*Note Chemotherapies are the main treatment for Leukemias

Who is At Risk For Leukemias?

Having a brother or sister with leukemia

Being white or Hispanic

Living in the United States

Being exposed to x-rays before birth

Being exposed to radiation

Past treatment with chemotherapy or other drugs that weaken the immune system

Having certain changes in genes or genetic disorders, such as Down syndrome

Meet Emma Bulich

She was diagnosed with T- Cell Leukemia on Christmas day of 2010

T- Cell Leukemia Facts

A T - cell is a type of white blood cell that directly helps body’s immune system fight infection.

This year, an estimated 47,150 people of all ageswill develope at type of T-cell Leukemia

In general, leukemia can be caused by a genetic mutation (change) that is inherited (passed from generation to generation within a family) or environmental factors, such as smoking or exposure to chemicals or radiation. However, most often the cause of leukemia is not known.

Race/Ethnicity. ATLL is more common in people of Japanese, West Indian, and African American descent.

Meet the Lymphomas Fighters, Angels, & Survivors

What is Lymphoma?

Lymphomas are cancers of the lymphatic system, a series of olive-sized nodes that produce lymph, a fluid that carries disease-fighting white blood cells (lymphocytes) throughout the body. There are two types of lymphocytes affected by lymphoma: T cells and B cells, although B cell lymphomas are much more common.

How many types of Lymphomas are there?

There a 4 main types:

Hodgkin's Lymphoma (HL)mostly occurs in adolescents and young adults aged 15 to 35. It's slightly more common in males and tends to be more aggressive in older patients.

Burkitt's Lymphoma (BL) is an aggressive, fast-moving cancer affecting B cell lymphocytes. It is quite rare in the U.S., but much more common in countries near the equator, particularly Africa and South America.

Lymphoblastic Lymphoma (LBL)mostly affects T cell lymphocytes and is similar to acute lymphoblastic leukemia (ALL). It makes up about one-third of all childhood Non-Hodgkin's Lymphoma (NHL), and is more common in boys.

Large Cell Lymphoma (LCL)includes two subtypes: diffuse large B-cell lymphoma (DLBCL) mostly affects pre-adolescent and teenaged children; and anaplastic large cell lymphoma (ALCL) is more common in adolescents.

There are other types of lymphoma that occur in children. These include the following:

Lymphoproliferative disease associated with a weakened immune system.

Rare non-Hodgkin lymphomas that are more common in adults than in children.

What are the Signs & Symptoms of Lymphomas?

Specific lymphoma symptoms vary according to disease type, but most have the following symptoms in common:

Painless swelling or enlargement of lymph nodes, especially in the neck, armpits and groin

Excessive night sweats

Unexplained fever

Undetermined weight loss

Loss of appetite

Itchy ski

NOTE:

* If cancer involves the lymph nodes in the center of the chest, pressure from this swelling may trigger an unexplained cough, shortness of breath, or problems in blood flow to and from the heart.

How is Lymphoma Diagnosed?

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. One of the following types of biopsies may be done:

Excisional biopsy: The removal of an entire lymph node or lump of tissue.

Incisional biopsy: The removal of part of a lump, lymph node, or sample of tissue.

Core biopsy: The removal of tissue or part of a lymph node using a wide needle.

Fine-needle aspiration (FNA) biopsy: The removal of tissue or part of a lymph node using a thin needle.

Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone.

Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, orradioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.

Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.

Endoscopy:A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.

Mediastinoscopy: A surgical procedure to look at the organs, tissues, and lymph nodes between the lungsfor abnormal areas. An incision (cut) is made at the top of the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer.

Anterior mediastinotomy: A surgical procedure to look at the organs and tissues between the lungs and between the breastbone and heart for abnormal areas. An incision (cut) is made next to the breastbone and a mediastinoscope is inserted into the chest. A mediastinoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. This is also called the Chamberlain procedure.

Thoracoscopy: A surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope is inserted into the chest. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer. In some cases, this procedure is used to remove part of the esophagus or lung.

Thoracentesis: The removal of fluid from the space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells.

Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

How is Lymphoma Staged?

After childhood non-Hodgkin lymphoma has been diagnosed, tests are done to find out if cancer cells have spread within the lymph system or to other parts of the body.

The process used to find out if cancer has spread within the lymph system or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Some of the tests that are used to diagnose childhood non-Hodgkin lymphoma are also used to stage the disease. The following tests and procedures may be used in the staging process:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:

The number of red blood cells, white blood cells, and platelets.

The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.

The portion of the sample made up of red blood cells.

How is Lymphoma Treated?

Treatment for childhood non-Hodgkin lymphoma is based on whether the cancer is low-stage or high-stage. Low-stage lymphoma has not spread beyond the area in which it began. High-stage lymphoma has spread beyond the area in which it began. Stage I and stage II are usually considered low-stage. Stage III and stage IV are usually considered high-stage.Common Treatments:

Chemotherapy

Radiation Therapy

Surgery

How is Most likely to get Lymphoma & what are the Statics for Lymphomas?

Risk for Childhood LymphomaBoth Hodgkin disease and NHL tend to occur more often in people with certain severe immune deficiencies — including people with inherited immune defects, adults with human immunodeficiency virus (HIV) infection, or those who have been treated with immunosuppressive drugs after organ transplants.

Although no lifestyle factors have been definitely linked to childhood lymphomas, kids who have received either radiation treatments or chemotherapy for other types of cancer seem to have a higher risk of developing lymphoma later in life.

In most cases, neither parents nor kids have control over the factors that cause lymphomas. Most lymphomas come from noninherited mutations (errors) in the genes of growing blood cells. Regular pediatric checkups can sometimes spot early symptoms of lymphoma in the relatively rare cases where this cancer is linked to an inherited immune problem, HIV infection, prior cancer treatment, or treatment of immunosuppressive drugs for organ transplants.

Non-Hodgkin Lymphoma (NHL)There are about 500 new cases of non-Hodgkin lymphoma diagnosed each year in kids in the United States. It may occur at any age during childhood, but is rare before age 3. NHL is slightly more common than Hodgkin disease in kids younger than 15 years old.

In non-Hodgkin lymphoma, there is malignant growth of specific types of lymphocytes (a kind of white blood cell that collects in the lymph nodes). Malignant growth of lymphocytes is also seen in one of the forms of leukemia (acute lymphoblastic leukemia, or ALL), which sometimes makes it difficult to distinguish between lymphoma and leukemia in children. In general, people with lymphoma have no or only minimal bone marrow involvement, whereas those with leukemia have extensive bone marrow involvement.